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Central airway obstruction and particularly tracheal stenosis is a clinical problem where definite resolution is a tracheal resection, evaluating the magnitude, length, and ventilatory compromise of patient. The resectable fragment is limited to 30% of the total length in children, or 6 cm in adults with terminal end anastomosis. The replacement of longer sections through allogeneic transplantation has been disappointing due to the unfeasibility of the organ, rejection of the graft, and the highly complicated surgical procedure. Tissue bioengineering has designed the replacement of functional organs generated in vitro in the short term, with the absence of immunological responses to the graft. This is based on a non-biological matrix where epithelial and mesenchymal cells are planted in such a matrix. In this document, we review the history and development of trachea transplantation in Mexico as well as the application of these new technologies in the context of its world development, which is a reality in other countries as a new alternative in obstructive illness of the airway.

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Latin America started its transplant activity early-as soon as the first transplants in the world took place. Its member states have created their laws of donation and transplantation also. The first laws for transplants in the region were created in Brazil in 1963. Subsequently, all states approved its regulatory framework for transplants. Until 2012, Nicaragua was the only country in the region that did not have a transplants law. In October 2013, Nicaragua adopted the "Law on Donation and Transplantation of Organs, Tissues and Cells for Human Beings," which consummates the process that creates the legal framework for donation and transplantation in Latin America, a journey of 50 years' duration, from Brazil's law to Nicaragua's law. This achievement is the fundament for searching an exercise of transplantation in a ground of accessibility, equity, ethics, and transparency as part of comprehensive health care services in the region.

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Brazil is a country with over 190 000 000 inhabitants and a health system composed of a large public, government managed system. Between 1999 and 2010 the number of deceased donors increased by 161%, from 3.8 to 9.9 pmp, and the number of solid organ transplants increased by 121%, from 2891 to 6402. This growth was a consequence of the creation of a well-organized national transplant program. Government funding, decentralization and educational investment in transplant coordinators and related professional were decisive. In 2009 Brazil was the second largest country in the absolute number of kidney transplants (n = 4259). There are significant region disparities in performance which are mainly due to the development status. Improvements in transplant and research regulations resulted in an increasing participation of Brazilian transplant centers in multicenter trials, reaching over 44 studies during the last 11 years. Brazilian centers have been involved in clinical trials using everolimus, sirolimus, fingolimod, mycophenolate mofetyl, mycophenolate sodium, tacrolimus modified-release, sotrastaurin, belatacept, JAK3 inhibitor CP690,550 and valganciclovir. The still increasing number of transplants performed every year along with more efficient regulatory and sanitary analysis, organized clinical research programs and reduction in region performance disparities will eventually increase even more the participation of Brazil in trials worldwide.

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BACKGROUND: Organ transplantation is one of the highest forms of medical procedures due to the many technical implications as well as to new frontiers to be conquered while searching for new therapeutic options that reach far beyond ordinary decisions. Although technical skills were developed primarily, it was not until immune reaction to rejection was understood and control of biological variables achieved that transplantation acquired a greater scope. Bioethical performance is currently a challenge. As a human multidisciplinary activity, this is not without bias or skew. Therefore, the social and cultural context in the deontological and bioethical sense acquire the greatest relevance, particularly when values and principles inherent to human life are taken into account along with the complex angles derived from human interactions in the bioethical triangle. CONCLUSIONS: This triangle is represented by the individual requiring an organ, the person who is the donor under specific circumstances, and the individuals who are responsible for procurement, transplantation and evaluation of the validity of this therapeutic option.

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El Centro de Trasplante de Clínica Las Condes se formó en 1994, doce años después de fundada la institución, con el objetivo de aplicar las técnicas de los trasplantes de órganos sólidos a receptores con insuficiencia de variados órganos abdominales y torácicos. Quince años después se pueden mostrar resultados que considerados en sus conjuntos son inéditos en el país: 212 trasplantes hepáticos, 179 trasplantes renales, 60 trasplantes de pulmón, 20 trasplantes cardiacos, 13 trasplantes combinados de páncreas y riñón, 2 de intestino y uno de islotes de páncreas. Los resultados clínicos son comparables a los de centros especializados de países desarrollados. Además, se han procurado órganos dentro y fuera de la institución, se ha realizado docencia de post grado en Trasplante para médicos y enfermeras, se ha hecho investigación básica y clínica en alianza con la Universidad de Chile, se ha innovado tecnológicamente para ofrecer una terapia actualizada y segura. Todo ello ha sido posible por la constitución de un sólido equipo de trabajo asentado en una institución eficiente que estimula el progreso y el perfeccionamiento.

The Transplantation Center of Clínica Las Condes was created in 1994, 12 years after the initiation of the based institution, with the purpose of offering to Chilean patients who suffer end stage solid organ disease a modern therapy. Fifteen years after the numbers of multiorgan transplants speak by themselves: 212 liver transplants, 179 renal transplants, 60 pulmonary transplants, 20 cardiac transplants, 13 combined pancreas and renal transplants, 2 intestine grafts, and one pancreatic islet transplant. Clinical resulst are comparable to those shown by centres of more developped countries. In addition, an active organ procurement system have been installed locally providing organs to the organ distribution Chilean system. Also, associated to the University of Chile, post graduate teaching in the Transplantation area have been started dedicated to medical doctors and nurses and Basic and Clinical investigation have been performed with significant scientific production. All this was possible thanks to being installed in a solid health care institution that stimulate progress and improvement.

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This historical and bibliographic study aimed to understand how Nursing was organized to support care in transplantation. The HISA, LILACS, BDENF, PERIENF and DEDALUS databases were consulted, and thirteen references were found, ten of which were scientific articles, two were master's dissertations and one was a doctoral thesis. The span of time chosen for study ranges from the date of the first kidney transplant in Brazil (1965), to the date of publication of the last scientific article found in the databases mentioned above (2003). After reading these articles, the ones that were similar in topic were grouped together, thus creating the thematic axis for the presentation of the results. The results showed that the Nursing profession has played an important and active role in transplants ever since the first procedure in 1965.

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In 1968, publication of the Harvard committee's report concerning "irreversible coma" established a paradigm for defining death by neurologic criteria (brain death [BD]). Five years earlier, Dr. Guy Alexandre, a Belgian surgeon, had not only adopted closely similar diagnostic criteria for BD but also applied those criteria in performing the first organ transplant from a brain-dead donor--a procedure many of his colleagues considered ethically unacceptable. To put those events into present-day perspective, the author reviewed the proceedings of a Ciba Symposium held in London in 1966 at which Alexandre introduced his pioneering view, obtaining information and documents from Alexandre and others who attended that meeting. Comparing Alexandre's approach with the Harvard report and later advances helps in understanding how both defining death by brain criteria and transplanting organs from a brain-dead donor have become morally tolerable today.

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En el presente artículo se analizan algunos de los problemas éticos que han ido planteando la donación y trasplante de órganos a lo largo de su historia, y cómo se han resuelto. Esos problemas han sido diferentes según la propia evolución de las técnicas (AU)

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En el presente artículo se analizan algunos de los problemas éticos que han ido planteando la donación y trasplante de órganos a lo largo de su historia, y cómo se han resuelto. Esos problemas han sido diferentes según la propia evolución de las técnicas

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